Anexo 2: Encuesta

AFFECTED BY OTHERS’ DRINKING

This section introduces a pyramid model that describes both the problems associated with others’ drinking that families and children experience and the responses required to manage these problems (e.g. child protection and police service responses). The pyramid model estimates the number of children at different levels of risk of alcohol-related harms. The pyramid draws together data from the 2008 HTO Survey presented in Chapter 4 and the child protection data from Chapter 8 into a comparative frame. From this it is apparent that much larger numbers of children than are seen in the apex of the pyramid are affected by the drinking of their families (See Figure 10.1).

Figure 10.1 Pyramid of risks to children affected by alcohol-related problems in Australia per year

Figure 10.1 broadly describes the proposed prevention strategies inherent in the pyramid model for public policy responses. Tier one (Children in child protection system where a carer’s problematic drinking is a factor) of the pyramid model addresses the most serious instances of alcohol-related harms to children and families. For example, alcohol-related child abuse and neglect and domestic violence deaths, injuries and harms appear in the apex of the pyramid and are managed by police, legal and social services. The services that meet the most serious needs in the public health model are described as ‘tertiary preventive services.’ Where possible tertiary preventive services aim to manage severe problems, limit further complications and prevent re-entry to the system (Holzer 2007; Last 1988).

Tier two (Children substantially affected by others’ drinking, not in the child protection system) of the pyramid includes children who have been affected substantially or “a lot” by alcohol, but who have not come to the attention of child protection authorities. This may include families in which one or more members are seeking assistance for their alcohol problems. These problems may not require action by police or child protection services, and may or may not be known to more than one social support service. In this tier, targeted services aim to prevent harms to the drinker but also to prevent families and children from progressing into a higher tier. Vulnerable families may also be receiving general services, e.g. Family Services, but may not have the alcohol-related problems of their family members identified or responded to.

There are no data for the second tier on either the number of children living in families where a member of the family is in treatment for alcohol problems, or the number of children in families receiving other

services where alcohol is identified as a problem for one or more members of the family. While there does seem to be the potential to record this information in the Victorian AOD data system, and the Auditor General’s report indicates that about one-third of AOD clients have dependent children, completion of this data field is not compulsory in AOD services, and therefore it is not well completed (Victorian Auditor General 2011). Thus, there is no accurate estimate of the number of vulnerable families that should be targeted with secondary prevention initiatives.

Tier three (Children affected in some way by others’ drinking) of the model includes a range of more minor problems (e.g. serious family arguments with heavy drinkers in the family, verbal abuse of children) that may not require service responses, and are not brought to the attention of any official services, but nevertheless affect a range of families, sometimes escalating and requiring attention from services at higher tiers of the pyramid. Although this group is described as being affected at least “a little,” the aim is not to diminish the seriousness of the situation for these children. It is also acknowledged that carers may not recognise that others’ drinking had affected (or how much it had affected) their child/ren. These more prevalent problems are best met by universal services and broad policies such as maternal and child services, financial aid, various forms of welfare, and universal alcohol harm prevention policies (Arney & Scott 2010).

The third tier, as well as the second tier, may hold children from families where more serious and/or sporadic alcohol-related problems are hidden from authorities and services. As child protection researchers have noted, only a proportion of child abuse and neglect incidents will be observed by others beyond the parent and the child (Creighton 2004). These children are not necessarily experiencing less harm than children in families who have come to the attention of authorities or service providers: in fact, in some cases these children in families in which there has been no motivation to seek help for problems, or no intervention from authorities, may be suffering more severe harms.

Tier four includes those families at risk because they live with someone consuming alcohol at risky levels, but are not currently affected by that person’s drinking. The available evidence does not indicate whether this drinking is taking place in the presence or absence of children, therefore it is not clear whether children in this tier are witnessing their parent/s affected by alcohol or any after effects such as a hangover. Tier five comprises all Australian children who are at some additional risk because of exposure to general societal heavy drinking problems (Hope 2011). Alcohol is a legal product in Australia and its use has been normalised in everyday life. Even children in households where nobody consumes alcohol are still likely to be exposed to alcohol advertising and to people outside their household drinking.

In order to better reflect the harm to other family members as well as children caused by a family member’s drinking, further work is required: future iterations of this pyramid should incorporate national data on a broader range of problems and services.

10.4 A PUBLIC HEALTH APPROACH TO PREVENTING MANAGING ALCOHOL-RELATED

HARMS FOR FAMILIES AND CHILDREN

There is substantial agreement about how drinking can be problematic for families and children. However, there are less consistent understandings about how different types of problems, for example child maltreatment, should be managed (Beck 1992; Douglas 1992; Goddard 1999; Tomison 2001). Expanding on this example, there is some consensus in Australia and elsewhere that channelling increasing numbers of children and families into child protection services is not the best way to provide care to families and children most at risk, and that keeping families intact as much as possible is preferable (Cummins et al. 2012; Tomison 2001). On the other hand, there may be unintended consequences of acting on these sentiments. In the UK, researchers have found, in cases involving substance misuse, and particularly in